DHB Governance Debate Around Fit for Purpose

The extent to which District Health Board governance was
‘fit for purpose’ was robustly debated in an evening
meeting of the NZ Institute of Health Management this week
in Auckland (3 December).

Attended by some 40
health managers, the audience included the Minister of
Health Honourable Tony Ryall, the Associate Minister of
Health Honourable Jo Goodhew and MP Dr Paul Hutchison.

In a session chaired by Stuart Francis, chairman of
Francis Group International, Dr Lee Mathias, Deputy Chair of
the Auckland District Health Board, Dr Tim Tenbensel of the
University of Auckland and Graeme Milne, chair of the
Waikato District Health Board shared their research,
experience and opinions.

There was general
agreement on a number of fronts:• Public
interest in transparency is not well served in the current
model • The current model of having a majority
of elected board members is a problem • Only few
DHB board members have qualifications to manage billion
dollar organisations• Evolving the model to a
majority of appointed members would lift board performance
Dr Mathias’ research in her doctoral thesis pointed
strongly to a much reduced number of elected board
positions. One of the most important attributes of
successful board members is the skill of ‘metaliteracy’
– the ability to assimilate multiple viewpoints as part of
a board’s decision making process.

She found far
too few DHB directors possessed the necessary skills for the
job.

Dr Tenbensel’s research, conducted in
collaboration with colleagues from two other New Zealand
Universities raise some issues around the value of existing
democratic mechanisms. He advocated for more consistent and
formal clinical leadership within DHBs and likewise found
the skill of ‘versatility’ of juggling different
imperatives a critical skill for board members.

Mr
Milne, an experienced corporate leader and professional
director, plainly stated that the level of performance he
has seen in the DHB sector simply would not be tolerated in
the commercial sector let alone of billion dollar
organisations with thousands of employees. He pointed to
the need for boards to act as coaches for managers grappling
with strategic issues, the lack of talent and the negative
consequences on performance of the current systems for
ensuring public transparency over DHBs.

The
President of the NZ Institute of Health Management, Jenni
Coles, thanked Francis Group for their continued support and
facilitation of the meeting. NZIHM has been the
professional association for promoting health management in
New Zealand since 1946. Francis Group is a leading health
performance improvement consultancy in England with
practices in New Zealand and Australia.

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